brief executive function assessment tool (beat): record form

Drug and Alcohol Network

Brief executive function assessment tool (BEAT)

Record form

aci.health.nsw.gov.au

Agency for Clinical Innovation

1 Reserve Road St Leonards NSW 2065 Locked Bag 2030, St Leonards NSW 1590 T +61 2 9464 4666 | F +61 2 9464 4728 E aci‑[email protected] | www.aci.health.nsw.gov.au

Produced by: ACI Drug and Alcohol Network, Advanced Neuropsychological Treatment Services and We Help Ourselves.

Further copies of this publication can be obtained from the Agency for Clinical Innovation website at www.aci.health.nsw.gov.au

Disclaimer: Content within this publication was accurate at the time of publication. This work is copyright. It may be reproduced in whole or part for study or training purposes subject to the inclusion of an acknowledgment of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those indicated above, requires written permission from the Agency for Clinical Innovation.

Preferred citation: Berry J, Nardo T, Sedwell A, Lunn J, Marceau E, Wesseling A, Zucco M, Sugden-Lingard S, Borchard T, Batchelor J and Shores EA. Brief executive function assessment tool (BEAT): Record form. Sydney: ACI; 2021.

SHPN (ACI) 200646 ISBN 978‑1‑76081‑501‑1

Version: V1; ACI_0309 [10/20] Date amended: February 2021

Trim: ACI/D20/3248

© State of New South Wales (NSW Agency for Clinical Innovation) and Advanced Neuropsychological Treatment Services, 2021.

The BEAT was designed to increase the capacity of alcohol and other drug services to screen for cognitive impairment and to be administered by frontline alcohol and other drug service workers. As many BEAT users will not be psychologists, it is strongly recommended that they watch the training video prior to administering the tool. The need to enhance the capacity of alcohol and other drug services to screen for cognitive impairment has been balanced against the need to ensure psychological tests are not misused or cause harm. Therefore, it is strongly recommended that BEAT examiners who are not psychologists seek the supervision of a psychologist if and/or when interpretation anomalies arise.

https://www.aci.health.nsw.gov.au

Test details

Examinee details

Name

Date of birth

Examination details

Date of test

Facility

Examiner details

Name

Position

Brief executive function assessment tool (BEAT): Record form February 2021

Agency for Clinical Innovation iii www.aci.health.nsw.gov.au

The test

Introduction Say: We’re about to have a look at your memory and thinking skills by asking you to do some mental tasks. You may find some tasks very easy and others a little challenging. It’s normal to experience some difficulties, the main thing is for you to try your best.

Prompt 1. Prospective memory end setupSay: At the end of this test I will say ‘that’s the end’. When I say that, I want you to remind me to ask about your schooling.

If you have already asked about the examinee’s schooling, then replace the word schooling with some other relevant phrase such as hobbies, talents or interests.

Tick this box when you have said that.

Instruction given

Item 1. Questionnaire1. Present response form Item 1 Questionnaire to

the examinee.

2. Say: To start with, I’ve got a brief questionnaire that asks on how many days out of the past seven days you experienced issues with your thinking or functioning. Would you like to complete it yourself, or would you prefer I read it to you?

3. Allow examinee to read and complete questionnaire.

4. If examinee has difficult reading, read the questions to them aloud and tick here:

ScoringAdd the total number of days for all 10 questions to get the raw score.

Raw score = /70

Raw score 0–9 10–18 19–29 30–70

Transformed score 3 2 1 0


Agency for Clinical Innovation 1 www.aci.health.nsw.gov.au

Item 2. Trail making1. Make sure you have a stopwatch to record the

time.

2. Present response form Item 2 Trail making to the examinee.

3. Say: I’d like you to start at number 1 and draw a line from 1 to A, A to 2, 2 to B and so on. Keep alternating between number and letter, as fast as you can until you reach the end here.

4. Point to each number and letter as you explain.

5. Use a stopwatch to time how long the examinee takes to complete the trail.

6. If the examinee makes a mistake, say ‘that’s not quite right, continue from here’. Cross out the error with two lines and point to the last correct number or letter. Do not stop timing.

ScoringTotal time taken to complete the trail (in seconds).

Raw score = seconds

Raw score 0–16 17–23 24–33 >33


Item 3. Clock drawing1. Present response form Item 3 Clock drawing.

2. Say: This circle represents a clock. Put in all the numbers so that it looks like a clock and then set the time to ten minutes past eleven.

ScoringThe raw score is the first two numbers that are drawn.

Raw score = ,

Raw score Neither are 12, 9, 6 or 3

One is 12, 9, 6 or 3

Both are 12, 9, 6 or 3

Transformed score 0 1 3



Item 4. Figure copying1. Present response form Item 4 Figure copying.

2. Say: Copy this diagram as accurately as you can over here. Point to the space below the design.

3. Remove the response form from the examinee when copy is complete.

4. Say: I would like you to remember that last drawing you copied because I will ask you to draw it again later on.

Prompt 2. Prospective memory bell setup1. After you’ve given the instructions for Item 4

Figure copying, introduce this prompt

2. Say: Also, if you see a bell, I want you to say to me, ‘that rings a bell’.

Tick this box when you have said that.

Instruction given

( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( )

Scoring• Give a point for each of the nine elements in Item 4

Figure copying that are drawn.

• An element must be clearly recognisable to attract a point, even if it is in the wrong location.

• Raw score is the total number of elements drawn.

Presented upside down below so scoring can be undertaken during drawing.

Raw score = /9

Raw score 0–8 9

Transformed score 0 3



Item 5. Word list learning1. Trial 1: Say: Now I’m going to say some words.

Listen carefully, because after I’ve said them, I want you to tell me as many of them as you can remember, in any order you like. Ready?

2. Read the words from left to right starting with ‘violin’ at a rate of one per second.

3. Trial 2: Say: I’m going to say all the words again and when I stop, I want you to tell me all the words from the list, including the ones you’ve already told me. Ready?


5. Trial 3: Say: I’m going to say all the words one more time and when I stop, I want you to tell me all the words from the list, including the ones you’ve already told me. Ready?


Scoring• Mark the words for each trial in the table.

• Count the total for each trial.

• Add the totals for the raw score.

Raw score 0–16 17–18 19–20 21


Trial VIOLIN STOVE FROG LIP SHIRT LETTUCE NURSE Total

1st

2nd

3rd

Raw score /21



Item 6. Attention span1. Say: I’ll say some numbers and I want you to

repeat them back to me in the same order. For example, if I say ‘3, 5’, what would you say?

2. Start with the sequence length of 5. Read the sequence at the rate of one number per second.

3. Go up if correct or down if incorrect. If going up, discontinue when the first error is made. If going down discontinue when the first correct response is made.

4. Write down the response provided in the table below.

ScoringThe raw score is the highest sequence length the examinee correctly repeats.

Sequence length Stimuli Response

7 3-1-9-7-5-8-4

6 7-6-1-4-5-8

5 Start Here -> 2-5-6-9-7

4 5-1-8-4

3 4-1-3

Raw score = /7

Raw score 0–4 5 6 7


Item 7. Working memory1. Say: I’ll say some more numbers and this time

I want you to say them in reverse order. For example, if I say ‘7, 2’, what would you say? They should say ‘2, 7’. If incorrect, explain again until the examinee understands the task.

2. Start with the sequence length of 3. Read the sequence at the rate of one number per second.

3. Go up if correct or down if incorrect. If going up, discontinue when the first error is made. If going down discontinue when the first correct response is made.

4. Write down the response provided in the table below.

ScoringThe raw score is the highest reverse sequence length the examinee achieves.

Sequence length Stimuli (Expected response)Response

6 2-4-5-8-6-9 (9-6-8-5-4-2)

5 2-5-6-9-7 (7-9-6-5-2)

4 5-1-8-4 (4-8-1-5)

3 Start here -> 4-1-3 (3-1-4)

2 9-6 (6-9)

Raw score = /6





Item 8. Attention span minus working memoryThis is not a question you have to ask the examinee. You calculate this item based on the raw scores of the previous two items.

ScoringRaw score is the Item 6 Attention span raw score minus the Item 7 Working memory raw score.

Attention span raw score

minus

Working memory raw score

= Raw score

Raw score <3 ≥3


3. Say: Now with your right hand, do the same series with me.

4. Perform series three times with the examinee.

5. Say: Now do it on your own.

6. Allow examinee six attempts.

ScoringTick for each fist-edge-palm trial that is performed correctly.

With you

1st trial 2nd trial 3rd trial

On their own

1st trial 2nd trial 3rd trial

4th trial 5th trial 6th trial

The raw score is the total number of trials examinee could gesture fist-edge-palm (in that order) on their own correctly.

Raw score = /6

Raw score 0–5 6


Item 9. Motor series1. Say: Look carefully at what I’m doing.

2. Perform fist-edge-palm (but do not say this out loud) three times with your left hand on the table (hand should touch the table with each movement).

Fist Edge Palm

Image ‘Fist-edge-palm’ from Leonidovna SA, Sergeevna, SA. The use of ‘The program of forming neuro-psychological space of junior schoolchildren’ in teaching process. International Journal of Professional Science.2016;(1)



Scoring key

Table – Chair Wind – Rain Salt – Pepper Salt – Seaweed

0 point examples

1 point examples

0 point examples

1 point examples

0 point examples

1 point examples

0 point examples

1 point examples

Matching

For dining

Made of wood

Four legs

Go together

Eat at them

Part of a set

Furniture Elements

Come from the sky or atmosphere

Nature

Environmental forces

Seasons

Precipitation

When there’s rain there’s wind

Weather Herbs or spices

Additives

Make food taste nice

Add flavour

Ingredients

Granulated

Comes from a shaker

Condiments

Added to food, goes on food

Seasoning

Start with S

Salty or have salt

Taste the same

Saltwater

Edible, eat them or food

Beach

Salt comes from the sea

Marine

From the sea or ocean

From water

Item 10. Abstraction1. Say: In what way are a banana and

orange alike?

2. Note the response and if anything other than ‘fruits(s)’. Say: Yes, and they’re both fruits.

3. Say: In what way are a table and chair alike?

4. Repeat for the other items in the table below in a similar fashion.

5. Record responses verbatim.

ScoringRecord one point for each correct answer. See scoring key for examples.

1. Table – Chair ( )

2. Wind – Rain ( )

3. Salt – Pepper ( )

4. Salt – Seaweed ( )

The raw score is the total number of points across the four word pairs.

Raw score = /4





Item 11. Letter fluency1. Make sure you have a stopwatch to record the

time.

2. Say: I’d like you to tell me as many words as you can think of that begin with a particular letter of the alphabet. Only give me words that start with that letter. Don’t tell me the names of people or places, and don’t give me the same word with different endings, like eat, eating, eaten, etc. Tell me as many words as you can think of, as fast as you can, that start with S. Go ahead.

3. Start the stopwatch.


5. Say: Stop after 60 seconds.

ScoringCount the total number of correct words for the raw score. Ensure you do not count words that are repetitions or rule breaks (e.g. names of people or places, or the same word with different endings).

Raw score =

Raw score 0–14 15–17 18–20 >20


List S word responses here



Item 12. Category fluency1. Make sure you have a stopwatch to record the

time.

2. Say: Next I will ask you to tell me the names of things that belong to a particular category. They can start with any letter. As fast as you can, tell me as many different names of fruits as you can think of. Go ahead.

3. Start the stopwatch.


5. Say: Stop after 60 seconds.

List fruit responses here

ScoringCount the total number of correct words for the raw score.

Raw score =

Raw score 0–13 14–15 16–18 >18




Item 13. Letter fluency minus category fluencyThis is not a question you have to ask the examinee. You calculate this item based on the raw scores of the previous two items.

ScoringThe raw score is the Item 11 Letter fluency raw score minus the Item 12 Category fluency raw score.

Letter fluency raw score

minus

Category fluency raw score

= Raw score

Raw score <-2 -2–0 1–3 >3


Item 14. Word list recall1. Say: A little while ago I read you some words

several times. I want you to tell me all the words again in any order.

2. For words that are not freely recalled, provide a category cue. If the word is not recalled with a category cue, immediately provide the multiple choice cue. See scoring table for these cues.

ScoringTo calculate the raw score:

a. multiply the free recall score by 3

b. multiply the category cued recall score by 2

c. add these amounts to the multiple choice cued recall score.

Raw score 0–15 16–17 18–19 20–21


Free recall Category cued recall‘One of the words was…’

Multiple choice cued recall ‘Was it…’

VIOLIN a musical instrument guitar, piano or violin?

STOVE something you find in a kitchen sink, stove or fridge?

FROG an animal frog, monkey or snake?

LIP part of a face cheek, lip or nose?

SHIRT an item of clothing shirt, jeans or singlet?

LETTUCE a vegetable carrot, lettuce or cucumber?

NURSE a profession lawyer, doctor or nurse?

Total Total Total

Total x 3 Total x 2 Total x 1

Raw score: Add total multiplied scores from each column



Item 15. Reading1. Present the BEAT: stimulus card to the examinee.

2. Say: Read these words for me out loud, starting at number one. Some of these are hard words that you may not have come across before. Just try your best to pronounce them correctly.

Scoring[ ]1. Address (pronounced like ‘a-dress’)[ ]2. Climb (pronounced like ‘clime’)[ ]3. Equestrian (pronounced like ‘e-quest-rian’)[ ]4. Liaison (pronounced like ‘lee-ayze-on’,

or ‘lie-ayze-on’)[ ]5. Ubiquitous (pronounced like ‘you-bick-weh-tus’)[ ]6. Anechoic (pronounced like ‘an-eck-oh-ick’)[ ]7. Vivace (pronounced like ‘viv-arch-ie’)

Add the total number of words pronounced correctly for the raw score.

Raw score = /7

Raw score 0–3 4 5 6–7




Item 16. Naming1. Present the BEAT: stimulus card to the examinee.

2. Say: What’s this a picture of? Point at each of the silhouetted drawings on the stimulus card, in the order below.

Image ‘Naming’ source: © 2006 Oxford Publishing Limited. Strauss, Sherman and Spreen. A Compendium of Neuropsychological Tests. Reproduced with permission of the Licensor through PLSClear

ScoringAdd the total number of items named correctly for the raw score.

Raw score = /15

Raw score 0–14 15


[ ] 1. Bird [ ] 2. Apple [ ] 3. Cloud [ ] 4. Guitar [ ] 5. Car

[ ] 6. House [ ] 7. Key [ ] 8. Bell [ ] 9. Gun [ ] 10. Horse

[ ] 11. Tree [ ] 12. Fish [ ] 13. Mushroom [ ] 14. Teapot [ ] 15. Saw



Prompt 3. Prospective memory bell response

Scoring• Give two points if the examinee responds to the

bell cue by correctly stating the phrase ‘that rings a bell’.

• Give one point if the examinee responds to the bell cue but cannot recall what they need to say.

• Give zero points if the examinee does not immediately respond to the bell cue (even though they might do so later).

Raw score =

Raw score 0 1 2

Transformed score See Item 20 Prospective memory score



1 $3 now or $10 in one week 15 $1 now or $10 in one week

2 $50 now or $100 in six months 16 $45 now or $50 in one month

3 $20 now or $100 in six months 17 $10 now or $100 in six months

4 $2 now or $10 in one week 18 $70 now or $100 in six months

5 $10 now or $50 in one month 19 $35 now or $50 in one month

6 $80 now or $100 in six months 20 $7 now or $10 in one week


8 $30 now or $100 in six months 22 $5 now or $50 in one month

9 $25 now or $50 in one month 23 $40 now or $100 in six months


11 $30 now or $50 in one month 25 $4 now or $10 in one week

12 $40 now or $50 in one month 26 $15 now or $50 in one month

13 $20 now or $50 in one month 27 $90 now or $100 in six months

14 $60 now or $100 in six months Total now = Total delay =

Item 17. Delay discounting1. Say: In a hypothetical situation where someone

is offering you money, would you prefer to receive… [name each of the options in the table].

2. Circle the amount the examinee selects.

ScoringAdd the total number of delayed choices for the raw score.

Raw score = /27

Raw score 0–10 11–15 16–21 22–27




Item 18. Visual memory1. Present response form Item 18 Visual memory to

the examinee.

2. Say: A little while ago, you copied a diagram. I want you to draw that diagram now as best as you can from memory.

ScoringThe diagram is presented upside down below so scoring can be undertaken during drawing.

• Give a point for each of the nine elements that are recalled.

• An element must be clearly recognisable to attract a point, even if it is in the wrong location.

• Add the total number of elements drawn from memory for the raw score.

Raw score = /9



( ) ( ) ( ) ( ) ( ) ( ) ( ) ( ) ( )



Item 19. Incidental learning1. Say: Earlier, I showed you a page with 15

silhouette drawings and I asked you to name them. I want you to tell me as many of them as you can remember.

ScoringTick the items recalled by the examinee on the record form (if they incorrectly named an item originally and used the same incorrect name in recalling it, give them a point).

Add the total number of correct items recalled for the raw score.

Raw score = /15

Raw score 0–5 6–7 8 9–15


[ ] 1. Bird [ ] 2. Apple [ ] 3. Cloud [ ] 4. Guitar [ ] 5. Car

[ ] 6. House [ ] 7. Key [ ] 8. Bell [ ] 9. Gun [ ] 10. Horse

[ ] 11. Tree [ ] 12. Fish [ ] 13. Mushroom [ ] 14. Teapot [ ] 15. Saw



Prompt 4. Prospective memory end response1. Say: That’s the end.

Scoring• Give two points if the examinee responds to the

cue by correctly asking the examiner to ask them about their schooling (or other topic mentioned in the setup).

• Give one point if the examinee responds to the cue but cannot recall what they need to say.

• Give zero points if the examinee does not immediately respond to the cue.

Raw score =

Raw score 0 1 2

Transformed score See Item 20 Prospective memory score

Item 20. Prospective memory score

ScoringAdd the raw score for Prompt 3 Prospective memory bell response and the Prompt 4 Prospective memory end response for the raw score.

Prospective memory bell response

plus

Prospective memory end response

= Raw score /4

Raw score 0–1 2–3 4

Transformed score 0 1 3

Education1. Say: What is highest level of education you’ve

completed? TAFE Certificates are not counted.

2. Clarify whether a qualification was attempted but not completed, but count full years completed only (e.g. if someone completed their first year of a Bachelor Degree, then count that as 13 years).

Scoring

Primary School (0-6 years)

Year 7 (7 years)

Year 8 (8 years)

Year 9 (9 years)

Year 10 (10 years)

Year 11 (11 years)

Year 12 (12 years)

Diploma/Adv. Diploma (13 years)

Associate Degree (14 years)

Bachelor Degree (15 years)

Honours Degree (16 years)

Masters Degree (18 years)

PhD (19 years)

Years of education =



1. Circle the transformed scores for each item in the table below.2. Add up the columns for 1, 2, and 3 scores.3. Add up the totals of those columns to calculate the BEAT total score.4. If the BEAT total score is 30 or less, this indicates the person has cognitive impairment.

Item Transformed score

Item 1. Questionnaire 0 1 2 3

Item 2. Trail making 0 1 2 3

Item 3. Clock drawing 0 1 3

Item 4. Figure copying 0 3

Item 5. Word list learning 0 1 2 3

Item 6. Attention span 0 1 2 3

Item 7. Working memory 0 1 2 3

Item 8. Attention span minus working memory 0 3

Item 9. Motor series 0 3

Item 10. Abstraction 0 1 2 3

Item 11. Letter fluency 0 1 2 3

Item 12. Category fluency 0 1 2 3

Item 13. Letter fluency minus category fluency 0 1 2 3

Item 14. Word list recall 0 1 2 3

Item 15. Reading 0 1 2 3

Item 16. Naming 0 3

Item 17. Delay discounting 0 1 2 3

Item 18. Visual memory 0 1 2 3

Item 19. Incidental learning 0 1 2 3

Item 20. Prospective memory score 0 1 3

Total score

Calculate the BEAT score

Cognitive impairment if BEAT score is 30 or less+ + =



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brief executive function assessment tool (beat): record form

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